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Sunday, September 18, 2016

Costing Us Our Conscience: The unbearably high price of conventional mental health

For me, the issue of force in psychiatry basically boils down this: In our deepest darkest hour, do we deserve the dignity of conscience?

To answer this question I think we have to decide what we believe, at core, is the nature of human nature. In other words, in our experience of ourselves and others, are human beings basically just selfish, self-interested, pleasure-seeking, profit-making machines…? Are we and others really mostly driven by material comfort, and quite happy to satisfy our own needs without regard to the cost to others?

If so, then force and coercion are probably our best bet. They’ll probably achieve the greatest good for the greatest number. They’ll make sure nobody steps too far out of line, and they’ll yank us back in when we do. They’ll communicate clear reward and clear consequences for the essential psychopathic nature in all of us.

Even better yet, if this is our true nature – if we really are nothing more than skin, bone and Pavlov’s estimation of his dogs – then force and coercion should work. We should get better rather than worse with such a rational, straight-forward, reward-punishment approach to our existence.

On the other hand, if we believe in the human spirit – in the beauty and dignity of every person … if we believe that we all have a conscience and deeply held beliefs and values and something to contribute of great value that is different from any other human being on this planet - then the damage we are doing to each other by force and coercion is beyond comprehension. In this latter context, these are the last things we would want to do to other human beings in the deepest, darkest hours that all of us will at some point face. Such approaches are the least helpful, most hurtful, most likely to make things worse rather than succeed – both short and long term -- than practically anything else we could come up with in good faith.

Here’s another thing to think about: The former view of humanity is really ideally suited to the modern business world. There, the values and priorities are for people who shut down their values, initiative and dreams. The most important task is to fit into the cog of the corporate wheel and conform your will to industry needs during the 8+ hour day.

The latter view of humanity is basically the human rights model: The human rights model goes to great lengths to protect the personhood of every one of us. It says we are all equal in dignity and rights. We are all endowed with reason and conscience. It holds space for us all as people with potential. It believes in and values the unique contributions that we were all born into this world in order to make. Universal Declaration of Human Rights, http://www.un.org/en/universal-declaration-human-rights/

The critical difference between the business model and the human rights model is how we respond when someone gets uncomfortable. In the face of human discomfort, conventional mental health basically operates on the business model of human beings. Whether the discomfort is our own or that of someone else, conventional mental health steps in and supports the expectations of the established social order. In effect, it says:

You might have had a right to dignity, to draw your own conclusions (reason), to make your own decisions, and to operate based on your own values (conscience) before, but now you have made other people uncomfortable. So, from here on out, we’re going to police that. When you stop making everyone so uncomfortable, we’ll give you back as much dignity and freedom as we feel you can safely handle. The choice is yours. You keep making us uncomfortable and we’ll keep your rights forever. You start acting in ways that reassure us that you're on board, we’ll dole your rights back incrementally and see how you do. Until then, however, we're the guardians of your personhood. If you want to exercise it, you need to come to us first.

In other words, the mental health system essentially operates on the assumption that rights are relative: Rights are conditionally allowed based on demonstrated ability to conform to established social norms. If the ability to do this comes into doubt, rights may be withdrawn by experts who presume to know what is best for the person and society at large.

The human rights view is very different. It fundamentally respects the dignity, perceptions, understandings and values of every human being on an equal basis with all others. In the face of discomfort or human differences, it tries to start an honest conversation: I feel uncomfortable. I’m not sure what is going on here. I’m not sure if it’s you, me or something different altogether. Can we talk..?

The human rights perspective assumes people are doing things -even very uncomfortable things - for some good reason that makes sense to them. It doesn’t automatically assume that one person’s reasoning is better than another. It doesn't automatically assume that the way things have always been done is the best way. It doesn’t automatically assume that there is a right way to think or act in a given situation.

Rather, the human rights perspective supports people to make sense of their differences and the human needs, values and perspectives that underlie them. Thus, it tries to understand why those involved are feeling what they are feeling and responding the way they are responding. It tries to understand the outcomes they value and the life experiences that make them seem important. It tries to understand logical connections and the reasons people believe in the choices they are making in the moment.

In other words, instead of stripping people of their right to dignity, reason and conscience, the human rights perspective affirms people’s dignity. It supports all concerned to express their concerns, maximize their rational capacities and to realize their deepest values. It helps those involved to make sense of what is happening, to get in touch with what they care about the most, and to find a way to proceed with due regard for the personhood of all concerned.

Instead of picking winners and losers or substituting the judgment of so-called experts, the human rights approach supports those involved to regard each other as persons and negotiate concerns in good faith. Instead of shutting down inquiry, the human rights approach supports people to create new knowledge. Instead of shutting down conflict and discomfort, the human rights approach supports people to navigate it and learn from it.

In other words, the human rights approach is about supporting us to develop our full potential - as individuals, family members, friends, neighbors and community members. The role of helpers is to support people to regard each other as valued members of a human community - and to reach a greater understanding and appreciation of the needs and experiences of all.

The conventional mental health approach is about shutting down discomfort and keeping business operating smoothly.

I don't know about you. But, in my world, there are far too many widgets and far too little humanity. I'd like to see a mental health system that - instead of rotely producing more and more of the same stuff nobody really needs - actually contributed to something that felt like human development.

do you think that psychiatry, and people who use psychiatry against another person (like a family member calling 911), are doing it from a behaviorist/pavlovian/ reward & punishment point of view? how does this square with their stated belief that they are doing it for the person's own good?

i think that the reward & punishment aspect is the essence of all coercion, but it is masked in psychiatry by this superficial motivation of good will and concern. at the same time i think those who do it also feel at a loss, and burdened by the other person's needs, and so coercion as an acting of taking control over the other person, managerial, isn't just reward & punishment directed to getting them to behave or not behave a certain way, but also putting them somewhere out of the way where you don't have to think about them any more.

this motivation is important and for me is the real reason why we need alternatives; because if it is about reward & punishment it's easy to see that everyone has an equal right to pursue their own vision, annoying as it may be to others, e.g. in our political election going on right now. and thinking about that, ok, i will just avoid people whose conduct or beliefs are annoying to me, i don't feel a need to engage with them at all, unless we're in a shared space and i can't get away from what annoys me. but i don't think this issue of annoyance in a shared space is about anything that is a distress of the individual person, for me it has really nothing to do with anything that could be psych-labeled, it's rather about differences in personal preferences and sensitivities that have to be worked out or just not be in the same space.

and it makes me think, maybe this is also what you mean about conflict. i think it is necessary to have the option to simply not be in the same space, that's hard when it's an issue of neighbors or public spaces like cities, and then we have to look at overall cultural norms and it's hard to deal with, because it becomes more than anything else an issue of power and control. and in particular because you can't have all the relevant people sit down together, how will you get the 8 million new yorkers in a discussion about city streets and subways, or even the 100 thousand or so in a small city?